Cardiac cephalalgia - Case report and review of the literature with new ICHD-II criteria revisited
ABSTRACT We report a patient with cardiac cephalalgia and review reported cases from the English-language literature based on the new diagnostic criteria published in the International Classification of Headache Disorders, ed 2. Twenty-two patients, including ours, with headaches of cardiac origin were reviewed. The cases fit three of the four new criteria well: Criteria B (acute myocardial ischemia has occurred, 100%), C (headache developed concomitantly with acute myocardial ischemia, 100%), and D (headache resolved and does not recur after effective medical or surgical treatment for myocardial ischemia, 83%). The cases in which we had exceptions were to the proposed headache features (criterion A), which were generally not fulfilled, with nausea as the least frequent finding (27%); this criterion might not be mandatory for diagnosis.
- SourceAvailable from: Giorgio Lambru
- "Fifty-seven per cent of patients shows pathological alterations of the baseline ECG trace, such as ST-segment elevations or depressions and T-wave inversions [5, 8–11, 13, 15–20, 25, 27–29], as well as elevated cardiac enzymes [5, 7, 10, 11, 16–20, 26, 27]. "
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ABSTRACT: The purpose of this review was to provide a critical evaluation of medical literature on so-called "cardiac cephalgia" or "cardiac cephalalgia". The 2004 International Classification of Headache Disorders codes cardiac cephalgia to 10.6 in the group of secondary headaches attributed to disorder of homoeostasis. This headache is hardly recognizable and is associated to an ischaemic cardiovascular event, of which it may be the only manifestation in 27% of cases. It usually occurs after exertion. Sometimes routine examinations, cardiac enzymes, ECG and even exercise stress test prove negative. In such cases, only a coronary angiogram can provide sufficient evidence for diagnosis. Cardiac cephalgia manifests itself without a specific pattern of clinical features: indeed, in this headache subtype there is a high variability of clinical manifestations between different patients and also within the same patient. It "mimics" sometimes a form of migraine either accompanied or not by autonomic symptoms, sometimes a form of tension-type headache; on other occasions, it exhibits characteristics that can hardly be interpreted as typical of primary headache. Pain location is highly variable. When the headache occurs as the only manifestation of an acute coronary event, the clues for suspicion are a) older age at onset, b) no past medical history of headache, c) presence of risk factors for vascular disorders and d) onset of headache under stress. Knowledge of cardiac cephalgia is scarce, due to its rare clinical occurrence and to the scant importance given to headache as a symptom concomitantly with an ischaemic cardiac event.The Journal of Headache and Pain 02/2009; 10(1):3-9. DOI:10.1007/s10194-008-0087-x · 2.80 Impact Factor
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ABSTRACT: Cardiac cephalgia, or headache occurring as manifestation of myocardial ischemia, has only recently been recognized as a distinct entity. In patients with known ischemic cardiopathy, its diagnosis depends on the presence of severe headache that is accompanied by nausea, worsened by physical exercise, and only ceases with nitrate administration. We report on two patients who met diagnostic criteria for this entity. In both, headache was the only symptom of coronary ischemia, and delayed its diagnosis. Headache occurred both at rest and during exertion, and resolved only after the administration of nitrates. Cardiac cephalgia should be suspected in patients with a history of ischemic cardiopathy who present with de novo headache, even when thoracic pain is absent, especially if the headache improves with nitrates. Differential diagnosis with migraine is crucial to avoid the administration of vasoconstrictors.Revista Espa de Cardiologia 01/2006; 58(12):1476-8. DOI:10.1016/S1885-5857(06)60757-3 · 3.79 Impact Factor
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ABSTRACT: Myxospores consistent with species of Parvicapsula were observed in kidney of 15 of 95 (15.8%) adult pink salmon, Oncorhynchus gorbuscha, collected from the Quinsam River, British Columbia, Canada. The spores were elongate and curved with unequal valves, and 2 spherical-to-subspherical polar capsules within a highly refractile capsular region. The spores were unlike those of P. minibicornis found in nearby populations of Pacific salmon, Oncorhynchus spp. The spore dimensions were similar to those of Parvicapsula pseudobranchicola from Atlantic salmon, Salmo salar, in Norway, and the spores seemed similar to an undescribed Parvicapsula sp. from several Oncorhynchus spp. in Puget Sound, Washington. A sequence of 1,480 base pairs (bp) of the small subunit ribosomal RNA gene (SSU rDNA) of the parasite from pink salmon was most similar to, but distinct from, that of other Parvicapsula spp. The parasite is described as a new species, Parvicapsula kabatai n. sp. Polymerase chain reactions amplified a 158-bp sequence, unique to P. kabatai n. sp., from 22 of 93 (23.7%) adult pink salmon kidney samples, from 3 of 3 juvenile pink salmon collected in the ocean 125 km north of the Quinsam River, and from 2 of 5 archival coho salmon, Oncorhynchus kisutch, samples from Puget Sound. The parasite occurs within the lumen and epithelium of renal tubules and ducts, and within the renal interstitium. Concurrent infections with extrasporogonic stages of the myxosporean CKX, the microsporidian Loma salmonae, and a Myxidium sp. also were observed in the adult pink salmon.Journal of Parasitology 01/2007; 92(6):1313-8. DOI:10.1645/GE-940R.1 · 1.23 Impact Factor